Therapeutic response to benzodiazepine in panic disorder subtypes
Keywords:
Treatment, Panic, Disorder, Subtype, Respiration, ClonazepamAbstract
CONTEXT: This study makes a comparison between two subtypes of panic disorder regarding the clinical efficacy of clonazepam, a benzodiazepine. OBJECTIVES: To evaluate the clinical efficacy of clonazepam in a fixed dosage (2 mg/day), compared to placebo, in the treatment of panic disorder patients and to verify whether there are any differences in the responses to clonazepam between panic disorder patients with the respiratory and non-respiratory subtypes. TYPE OF STUDY: Randomized study with clonazepam and placebo. SETTING: Outpatient Anxiety and Depression Unit of the Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. PARTICIPANTS: 34 patients with a diagnosis of panic disorder with agoraphobia, between 18 and 55 years old. PROCEDURES: Administration of clonazepam or placebo for 6 weeks, in panic disorder patients, after they were classified within two subtypes of panic disorder: respiratory and non-respiratory. MAIN MEASUREMENTS: Changes in the number of panic attacks in comparison with the period before the beginning of the study; Hamilton Anxiety Scale; Global Clinical Impression Scale; and Patient’s Global Impression scale. RESULTS: In the group that received clonazepam, by the end of the 6th week there was a statistically significant clinical improvement, shown by the remission of panic attacks (p < 0.001) and decrease in anxiety (p = 0.024). In the group that received clonazepam there was no significant difference between the respiratory and non-respiratory subtypes of panic disorder, regarding the therapeutic response to clonazepam. CONCLUSION: Clonazepam was equally effective in the treatment of the respiratory and non-respiratory subtypes of panic disorder, suggesting there is no difference in the therapeutic response between the two subtypes.
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References
Klein DF. Importance of psychiatric diagnosis in prediction of clinical drug effects. Arch Gen Psychiatry 1967;(16)1:118-126.
Zohar J, Westenberg HG. Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand 2000;403(Suppl):39-49.
Versiani M, Nardi AE. O tratamento da doença do pânico: 1a aula. J Bras Psiquiatr 1989;38(6):301-10.
Fontaine R, Chouinard G. Antipanic effect of clonazepam. [let- ter]. Am J Psychiatry 1984;141(1):149.
Ballenger JC, Burrows GD, DuPont RL, et al. Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry 1988;45(5):413-22.
Chouinard G, Annable L, Fontaine R, Solyom L. Alprazolam in the treatment of generalized anxiety and panic disorders: a double-blind placebo-controlled study. Psychopharmacology 1982;77(3):229-33.
Beaudry P, Fontaine R, Chouinard G, Annable L. Clonazepam in the treatment of patients with recurrent panic attacks. J Clin Psychiatry 1986;47(2):83-5.
Pollack MH. Clonazepam: a review of open clinical trials. J Clin Psychiatry 1987;48(suppl):12-5.
Hyman SE, Arana GW, Rosenbaum JF. Handbook of Psychiat- ric Drug Therapy. Boston: Little, Brown and Company; 1995.
Tesar GE, Rosenbaum JF, Pollack MH, et al. Clonazepam ver- sus alprazolam in the treatment of panic disorder: interim analy- sis of data from a prospective, double-blind, placebo-control led trial. J Clin Psychiatry 1987;48(suppl):16-21.
Svebak S, Cameron A, Levander S. Clonazepam and imipramine in the treatment of panic attacks: a double-blind comparison of efficacy and side effects. J Clin Psychiatry 1990;51(Suppl):14-7.
Briggs AC, Stretch DD, Brandon S. Subtyping of panic disor- der by symptom profile. Br J Psychiatry 1993;163:201-9.
Lelliott P, Bass C. Symptom specificity in patients with panic. Br J Psychiatry 1990;157:593-7.
Bandelow B, Amering M, Benkert O, et al. Cardio-respiratory and other symptom clusters in panic disorder. Anxiety 1996;2(2):99-101.
First MB, Spitzer RL, Gibbon M, Williams JBM. Structured Clinical Interview Diagnostic (SCID) for DSM-IV axis I Dis- order-Clinician Version (SCID-CV). Washington, DC: Ameri- can Psychiatric Press; 1997.
American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders – DSM-IV. 4th edition. Washing- ton, DC: American Psychiatric Press; 1994.
Pols H, Zandbergen J, Lousberg H, de Loof C, Griez E. Low doses of clonazepam in the treatment of panic disorder. Can J Psychiatry 1991;36(4):302-3.
Davidson JR, Moroz G. Pivotal studies of clonazepam in panic disorder. Psychopharmacol Bull 1998;34(2):169-74.
Tesar GE, Rosenbaum JF, Pollack MH, et al. Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry 1991;52(2):69-76.
Tesar GE. High-potency benzodiazepines for short-term management of panic disorder: the U.S. experience. J Clin Psychiatry 1990;51(suppl):4-10.
Beauclair L, Fontaine R, Annable L, Holobow N, Chouinard G. Clonazepam in the treatment of panic disorder: a double- blind, placebo-controlled trial investigating the correlation be- tween clonazepam concentrations in plasma and clinical re- sponse. J Clin Psychopharmacol 1994;14(2):111-8.
Judd FK, Burrows GD. Clonazepam in the treatment of panic disorder. Med J Aust 1986;145(1):59.
Rosenbaum JF, Moroz G, Bowden CL. Clonazepam in the treat- ment of panic disorder with or without agoraphobia: a dose- response study of efficacy, safety, and discontinuance. Clonazepam Panic Disorder Dose-Response Study Group. J Clin Psychopharmacol 1997;17(5):390-400.
Moroz G, Rosenbaum JF. Efficacy, safety, and gradual discon- tinuation of clonazepam in panic disorder: a placebo-control- led, multicenter study using optimized dosages. J Clin Psychia- try 1999;60(9):604-12.
Valença AM, Nardi AE, Nascimento I, Mezassalma MA, Lopes FL, Zin WA. Ataques de pânico provocados pelo dióxido de carbono: estudo clínico-fenomenológico. Rev Bras Psiquiatr 2001;23(1):15-20.
Biber B, Alkin T. Panic disorder subtypes: differential responses to CO2 challenge. Am J Psychiatry 1999;156(5):739-44.
Mavissakalian MR. Phenomenology of panic attacks: respon- siveness of individual symptoms to imipramine. J Clin Psychopharmacol 1996;16(3):233-7.